Healthcare Provider Details

I. General information

NPI: 1598778078
Provider Name (Legal Business Name): STEFAN FARRELL RNFA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

PO BOX 30361
MESA AZ
85275-0361
US

V. Phone/Fax

Practice location:
  • Phone: 480-844-9817
  • Fax: 480-461-9195
Mailing address:
  • Phone: 480-844-9817
  • Fax: 480-461-9195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP2800X
TaxonomyPerioperative Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. STEFAN BRICE FARRELL
Title or Position: OWNER
Credential: CNS, CRNFA
Phone: 480-844-9817